| NPI | 1003817925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 18329) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WI 18329) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 18329) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2014-08-01 |